POS0764 CLINICAL AND LABORATORY FINDINGS IN PRIMARY SJOGREN’S SYNDROME PATIENTS WITHOUT SUBJECTIVE SICCA SYMPTOMS
Authors: V. Koulouri, L. Chatzis, C. Baldini, A. Goules, A. Tzioufas
Journal: Annals of the Rheumatic Diseases (2022)

Background Sjogren’s syndrome (SS) is a systemic autoimmune rheumatic disease characterized by symptoms of dryness. In fact, subjective manifestations of dry eyes or dry mouth are part of the inclusion criteria of the 2016 ACR-EULAR Classification Criteria for primary SS (pSS). However, some patients with SS diagnosis may present without subjective dryness, meeting the inclusion criteria based on the EULAR SS disease activity index (ESSDAI) questionnaire (1). Studies on non-dryness SS patients are missing. Objectives To describe the clinical phenotype of pSS patients who lack subjective dryness symptoms. Methods From 1738 consecutive pSS patients who fulfill the 2016 ACR-EULAR Classification Criteria for primary SS and were followed up in 4 centers from Greece and Italy (Universities of Athens, Pisa, Harokopio and Ioannina) (PAHI group), those without sicca symptoms were identified (non-Dryness Group) (1). Cumulative, clinical, laboratory, immunologic and histologic data were collected and compared with age, gender and disease duration-matched SS patients with both oral and eye dryness in 1:2 ratio (Dryness Group) (Table 1). Statistical analysis for categorical data was performed by Fisher exact test or χ2 square test accordingly and numerical data with Mann-Whitney test or t test. Table 1. Comparison of clinical and laboratory features of pSS patients with (Dryness Group) and without sicca manifestations (Non-dryness Group) Clinical and Laboratory features Non-Dryness Group, %, n=38 Dryness Group, %, n=76 p-value ANA positivity % 100 95.9 0.55 RF positivity % 58.3 64.3 0.7 Anti-Ro positivity % 100 90.8 0.09 Anti-La positivity % 54.1 50.7 0.89 Salivary gland biopsy positivity % 93.9 89.8 0.71 Focus score 2.12 2.19 0.97 Ocular tests positivity % 55.6 93.9 &lt;0.001 Salivary gland enlargement % 26.3 30.3 0.83 Arthralgias % 52.6 56.6 0.84 Arthritis % 25.7 17.6 0.48 Raynaud’s phenomenon % 23.7 27.6 0.82 Palpable purpura % 7.9 18.4 0.17 Lymphadenopathy % 22.6 20.3 0.99 Leukopenia % 20.7 26.1 0.76 Lymphopenia % 0 17.3 0.049 Neutropenia % 20.8 5.8 0.1 Thrombocytopenia % 13.8 3.1 0.07 Low C4 % 23.3 30.3 0.65 Cryoglobulinemia % 10.5 3.9 0.3 Lymphoma % 10.8 6.7 0.47 Results Thirty-eight SS patients were found without sicca manifestations (2.19%). The most common presenting clinical manifestation of non-dryness pSS patients were arthralgias (47.4%), followed by parotid gland enlargement (23.6%), Raynaud’s phenomenon (10.5%), generalized lymphadenopathy (10.5%), fatigue (10.5%), palpable purpura (5.3%) and pulmonary symptomatology of dry cough or exertional dyspnea (5.3%). Despite the lack of ocular dryness, non-dryness group had positive ocular tests but statistically lower compared to those with sicca symptoms (55.6% vs 93.9%, p&lt;0.001), and displayed lymphopenia less frequently (0 vs 17.3%, p=0.049). No statistical differences were found in terms of salivary gland enlargement (SGE), focus score (FS), cryoglobulinemia and autoantibody profile between the 2 groups. Conclusion SS patients without subjective dryness are characterized by similar underlying immunopathologic processes as typical SS sicca patients. References [1]Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjogren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017;69(1):35-45. Disclosure of Interests None declared